My husband has stage 4 heart failure only 15% of his heart is working. What does that mean?

I attend Alanon regularly. It has given me my life back. I live with an active alcoholicthay has cardiomyopathy and congestive heart failure. Ejection fraction is @ 25-30%. He chooses to continue drinking and eating poorly. Doctors can't help him understand the seriousness of his conditions. He has been on disability for 1 year. I have come to a realization that I didn't cause it I can't control it and I can't cure his alcoholism. I have learned to take care of myself and put him in Gods hands. So I hope you will find the rooms of Alanon soon.

Stage 4?. Yes to benefits. The sooner the task/ process of acceptance and the embrace of theadjustments & conciderations to daily life begin re: some new meds and routines etc. the sooner you can get busy living life. At the age of 47, I could no longer pretend it would soon pass, but I collapsed 1 day. I would have stood a good chance of improvement had I listened then instead of avoidance. There's a lot more I could say but I'll spare ya-laf..Take care

Er, you're all being quite quick to write this poor chap off. Yes his stats are alarming, especially for a first presentation; but his symptoms have improved radically with treatment in only three weeks. Unless there are other, complicating factors in the picture (like other alcohol-related disease, for example) he could be with us for some time yet. My mother's being tottering along on one cylinder, so to speak, for eighteen years.

But Viola, he has got to start taking this seriously. I'm glad the medicines are working, but he mustn't think that everything can now go back to normal. Any news since you last checked in?

Disability is not charity. It is what we as a society have set up to deal with people who have worked all their lives and suddenly find that they can no longer work. We all pay into this system as part of our employment taxes. Do not feel at all embarrassed or shamed that your husband needs this. Get the process of signing up started immediately.

This is apparently the first either of you knew about the heart failure, and it is already stage 4. This is very severe. Please make an appointment with his doctor and discuss exactly what the prognosis for your husband is. Is it time to involve Hospice Care? This is not charity, either. We all pay for Medicare and this is a service available through them.

Be very candid with the doctor. Will stopping drinking make any difference in your husband's prognosis? If he takes his drugs, how will that change the outcome? Would exercising help anything? What kind?

Personally, I would only encourage him to stop drinking etc. IF that could make a difference in the outcome. If the damage has already been done and nothing can substantially improve the situation, then I wouldn't use your last months together fighting about behaviors. However, if the outcome can be significantly improved, then trying to get hubby's cooperation is worth the effort.

So ... I think it is critical to talk to the doctor frankly about what impact various measures could have.

His heart disease is fatal and it is advanced. His body is likely weak from his addiction. Medicare will cover hospice, ask the doctor. Look to place him in a facility, at home hospice requires a relative be present (at least the firm we used, had that rule). A facility would be easier on you, so you do not have to deal with the addiction issue yourself, leave it to the professionals.
Take care

CM, I knew for quite awhile that my neighbors were not nice people, especially after having to shut windows to avoid hearing their swearing and shouting matches.

However, I wasn't mocking the live-in GF. If anything I was reflecting contempt for her attitude of using the system to get freebies instead of being responsible and working. But she's certainly not alone in that sense.

I too would be appalled to learn that someone was shooting up in my home. I often wondered in retrospect how many of the people I was working had been using something to enhance their performance over long working hours.

I understood that the drug of choice on Wall Street and similar was cocaine. And after all, it was good enough for Freud. I was very glad when my nephew returned to the Engineering fold after a stint in Futures.

GA it can't have surprised you that your neighbour was really not a very nice person! But aren't all addictions an affliction that we therefore shouldn't mock? I have particular trouble with gamblers on that score, I must admit. Ok I don't mock, but I do feel intense irritation.

Rich heroin users also escape detection pretty much indefinitely. Ten years after the event, a publisher friend of mine confessed to me that he had injected himself in my bathroom during a lunch party I'd invited him to. I was open-mouthed - Sunday afternoon at my home, my little children round the table, my husband carving the roast lamb and this guy is in the bathroom shooting up??? The confession was part of his rehab, though, which I suppose was some compensation.

But this is a tangent. Viola, get a diagnosis - a nice tidy one that you can show the Social Security people - from your husband's doctor. If he does turn out to be permanently disabled, and he has worked all his life, he must surely be entitled to support. First step is to find out. You shouldn't worry - not because there's nothing to worry about, but because it doesn't help. Getting busy will take your mind off things, and I'd be surprised if you didn't get some very positive answers to your questions. Best of luck, let us know how you get on.

Heart failure can be caused by excessive drinking over long periods of time. It is one of the few types of heart failure that can be reversed.

ShakingDust, thanks for the insights. What you write about substance abuse and higher performance unfortunately isn't a surprise. What surprised and shocked me was when I learned that some attorneys use cocaine to get an edge and get through marathon projects like takeovers and mergers, especially in high pressure environment of competitive NY law firms.

Interesting observation about the abuses that occur when people are at "high functioning levels." I couldn't help thinking of the massive abuses that occurred on Wall Street during the Recession.

And I read in one of your posts that you worked on a trading floor, if I understood correctly. I'm sure you've seen a lot that happened there that enhanced performance and was only considered normal and necessary to maximize one's potential. The push to make money for those kinds of firms must be incredible.

The alcoholic who bragged to me was not of the highest functioning level. She also bragged about how she scammed creditors. I think though that her alcoholism wasn't such in her own mind, but rather something she could manipulate to get what she wanted without working. To my knowledge she never even held a job.

Thanks again for the insight; I appreciate your perspective on these isues. In some respects, it helps understand some of the situations I've encountered over my own work life and didn't understand at the time.

Viola, start the SSDI application and do it now. Get Hospice in the picture too, because you need it now. So sorry

Me and my husband both work all our life, I never asked any one for help I have my pride. But I need to know what to do if he get so sick that he cant work, so I don't loose our house. Believe me I work 2 jobs to survive if I have to. I don't take drugs or drink just trying to get through this. And I don't need any one to feel sorry for me . thank you

ShakingDust, your comments on alcoholics and disability reminded me of something I became aware of about a decade ago. The neighbor, who was a drug abuser was living with his alcoholic mother, and his live-in GF who was also an alcoholic. The GF said something to me one day that alcohol was considered a disability - perhaps she used a different term but it was long ago and I don't recall everything she said.

But she was bragging that being an alcholic was the basis of getting free support of some kind. At that time I think it was psychological counseling.

She had no interest or intention of stopping drinking; for her it was a way to get things she wanted for free. I was too disgusted to inquire further so I don't know what other ways she found to exploit the system.

I do remember thinking that I'm a chocolholic and wondered what I could get for free? Hershey bars, maybe? Or better yet, Godiva chocolates? If I'm addicted, they're necessary, right? Seriously, this woman was so exploitive it just revolted me.

Ok, this chap is 57. Was busy working - i.e. functional, i.e. possibly still an alcoholic but not at rock bottom, or not yet anyway, or possibly a drinker but not actually an alcoholic - who knows? Viola? - and then got symptoms three weeks ago and now has been found to have heart failure.

Viola, you need to sit down, take deep breaths, and have a good, clear-eyed look at your husband's diagnosis and prognosis. Any of his doctors will be happy to explain his disease to you; but one of the key things you need to find out is what has caused his heart failure. It could be permanent damage to the muscle of his heart, but it isn't necessarily. Find out! Then you'll know what you're dealing with.

Asking/pleading with/begging an alcoholic, or indeed a hard-drinking man, to 'get help' is a perfect waste of breath and time. You have tried. It hasn't worked. If he won't listen to you, perhaps he'll listen to his doctors. If his behaviour is unacceptable and he won't listen to you, perhaps he'll listen to the police. If he is in fact an alcoholic then maybe support from Al-Anon would help - we know already that knowing you're not alone can take whole weights off your mind. It really doesn't matter who you get help from, but YOU have to make the first move by seeking help. You can't do this on your own.

Same thing with any social security you or your husband might be eligible for - make the first step! Ring them up and ask!

Come back to the forum and let us know how you're getting on. I'm sorry if I'm sounding brusque - actually I really do sympathise, but for things to get better you have to make it happen. Good luck, keep in touch.

My dad lived on 12% ejection fraction for over a year. When the heart muscle is damaged it does something amazing, it creates "collaterals" which are blood vessels that keep the blood flowing to the heart. The heart is really an amazing organ and will do as much as it can to protect itself.

Obviously, ejection fraction in the teens isn't good and it won't sustain someone indefinitely and it's not reversible. If your husband were to start eating heart healthy and quit drinking his heart condition wouldn't improve. Unfortunately the damage has been done.

I think your husband would be eligible for disability however it takes quite a while to go through that process. It would be wise to get started on that now. If you hire a social security disability attorney it would be quicker than doing it yourself because most people are turned down initially. You shouldn't have to pay the lawyer up front but a lawyer would get a percentage of any back payments you receive.

He fought me for 28 years to get help I know I have to be strong and I try. And he will not listen to me or that I am scared. I knew this day would come ,but now it hits me like a rock and I am numb.

The 15% figure is called the 'ejection fraction', and refers to how much of its blood content the heart pumps out in one beat. In a healthy adult it is around 65%, I believe. Don't panic! Although the figure is frightening, you have to remember some important (and I hope reassuring) things about it.

1. It is very hard to measure precisely. Your husband will have had an echocardiogram, which is like an ultrasound of his heart. The cardiac physiologist will have taken measurements of how well the blood was flowing through the chambers of his heart, and of how efficiently the heart was pumping.

2. 15%, although obviously it means the heart is not working well, is not the end of the world. My mother's last EF was measured at 10% - her GP gently explained this was their polite way of saying her heart is rubbish. And yet there she is, sitting in her chair, comfortable and content. You can toddle along for quite a while with poor heart function.

2. The breathlessness will have been caused by a build up of fluid in the lungs (water retention in the tissues), which is improved with diuretics. The trouble is that although diuretics work well, they do have side effects. But, again, my mother's been taking them, with occasional adjustments, since about 1996; and for the moment she is having no problems with fluid retention at all.

Viola, there are a lot of things you haven't mentioned that will make a difference. How old is your husband? What diagnosis has he been given underlying this heart failure (there can be all sorts of causes)? And regarding the alcohol, how much is he drinking, and what is he drinking?

A Scotch or two after dinner, OR a glass of red wine with dinner, OR a beer in front of the tv - these won't hurt him. A bottle of vodka will. If you're worried about how much he's consuming, or that he's unhealthily dependent on alcohol (it's the need, not just the amount, that you want to watch) then discuss it with his doctor.

If you can provide a little more information we could perhaps suggest other sites that would be helpful for you. Try not to worry too much, there are many treatment options available and you will almost certainly find that his doctors can sort him out with a good care plan. He'll need to co-operate, but it doesn't have to ruin his enjoyment of life.

Thank you so much for your answer. The doctors say they want to try the medicine first. They cant do nothing right now because his heart is so weak. I know its between him and god right now. I just feel lost right now , and don't know where to turn to .My 27 year old son is trying to be strong for me and I am for him. But my husband is in denial about his heart problem. The doctors told him he is on the end of the cliff, no going forward or back. Is this really the end, I don't know what to think anymore .Thank you again for caring.

Viola, you're probably referring to ejection fraction, which is a measure of the amount of blood that's pumped from your husband's heart when it beats.

This is a very good explanation of ejection fraction and how it works.

http://www.mayoclinic.org/ejection-fraction/expert-answers/faq-20058286. If the link is deleted, Google "ejection fraction" to get other hits on explanation.

Note that it also states that 55% is normal. So 15% is quite low, and dangerous.

There are 2 classifications of heart failure stages: one is alpha and the other numeric. I couldn't successfully get a link on the American Heart Assn. page which describes the 4 stages - it might be a problem with my browser. But Google "stage 4 heart failure" and check out the hits.

Be prepared; stage 4 is not a good place to be. I don't wish to be an alarmist, but if you haven't already, you should get your estate planning affairs in order, especially if your husband won't stop drinking.

Your husband has probably been prescribed Warfarin/Coumadin, an anticoagulant which thins the blood to reduce the event of clotting, as his heart is not pumping out as much blood as it should and that can increase the likelihood of a blood clot. He may also have been prescribed "baby" (81 mg.) aspirin as it also is a blood thinner.

You asked for advice: get him to join Alcoholics Anonymous, NOW. TODAY. That's the best thing both of you can do for his health.

Honestly, I don't know much about SS disability but it seems that his disability is self-induced so I'm not sure why he would qualify for it.

If you're religious, get his pastor to support you in getting him to join AA. If you have family, get their support also.

This is a real wake-up call for your husband and he needs to stop drinking ASAP.

He really does need to stop drinking. I know hes probably depressed, but let him know to help himself and you, he has to quit, there are pills and therapy for depression. What about stints to open his blood flow, if this is a problem, has he had an Angiogram? Im unsure if he would qualify for heart surgery or a pacemaker because of the stage he's in, what does his Cardiologist say? You should check with a disability lawyer today, but the drinking issue might not help. Your in my thoughts